After Joint Replacement, Why Do I Need Antibiotics to See the Dentist

After you have a new knee or hip joint, you’ll hear your orthopedic surgeon caution you about taking antibiotics before you see your dentist. McLeod Orthopedic Surgeon Rodney Alan, MD, explains the important reasons for this:

Here are highlights from Dr. Alan’s comments:

Do I need antibiotics when I go to the dentist for the rest of my life? This is a controversial topic.

What joint replacement surgeons worry about are bacteria from one part of your body getting into your joint replacement. That means you’ll need a revision (or a new replacement).

A dentist usually does some type of procedure that causes bleeding in your mouth. When there is bleeding in your mouth, normal bacteria that belong in your mouth can get into your blood stream. If bacteria get on your prosthesis (joint replacement material) the joint will become infected and you will need yet another joint replacement or revision.

Why does this apply only when you have a joint replacement? The materials in a joint replacement cannot fight off bacteria. The metal objects get bacteria on them. The bacteria build a slime mold over the joint and make you sick.

Most of the time, joint replacements that become infected are painful. They don’t necessarily cause fever. They just hurt. So, when you come to the Orthopedic Specialist’s office with a joint infection, we may ask if you’ve had any dental work done lately, other infections, abscesses in your teeth or needed hospitalization for a urinary tract infection.

I’ve done some revisions where an organism in an oral abscess was the exact same organism that was in the knee joint. So, I know it can happen. But the issue is controversial.

What do I tell my patients? For the first 2 years after joint replacement surgery, if you are having major dental work (drilling, removing a tooth), where there is pulp exposed to your saliva, then I tell you to take amoxicillin (2 grams) before your dental procedure. If you need a prescription, you can call your Orthopedic Specialist to write it. Or your dentist may be able to write it. If you’re allergic to penicillin, we’ll give you Cleocin.

This is only for major dental work. Not for a tooth cleaning..

Diabetics are at higher risk for infection. Also, people with Rheumatoid Arthritis are at higher risk for infection. If I were in one of those 2 categories, I would not stop taking antibiotics at 2 years.

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